Application of digital technologies in nursing practice: Results of a mixed methods study on nurses' experiences,...

Even though the importance of nurses' participation in the process of technology development is frequently stressed by stakeholders, participation has been described as negligible and limited by nurses' abilities to identify and communicate their needs and ideas for application scenarios or the improvement of digital nursing technologies (DNT) in everyday care practice. Prior research often uses hypothetical scenarios or laboratory settings with little real-world relevance, and the number of studies investigating needs for technology development, application scenarios or requested technologies from the perspective of nurses with experience in technology use is exceedingly small. Against this background, this study aims to investigate needs, application scenarios and perspectives of nurses with practical experience in real-world DNT application in a range of different care settings.

An explanatory sequential mixed methods design including an online survey (QUANT) and focus group (FG) discussions (qual) was used to explore nurses' perspectives and experiences. A convenience sample of participants was accessed via 19,000 e-mail contacts of directors of nursing (DONs) in care facilities and hospitals throughout Germany. Preliminary results of the online survey were discussed and elaborated in depth in three FGs. Quantitative results of the online survey were included in the development of the interview guideline for and data collection from the FGs. Descriptive, setting-specific analysis was conducted for quantitative data, and qualitative data was analysed by identifying key aspects.

A total of 1,335 participants took part in the online survey, most of whom worked in ambulatory care institutions and held management positions such as DON or team leader. There were 14 FG participants. Ninety-five per cent of the participants of the online survey reported having experience in the use of DNT, predominantly with information and communication technologies (ICT). Overall, DNT were deemed to make work easier, and participants concurred on other positive effects such as increased efficiency or saved time and improved quality of care. Negative effects or concerns were reported less frequently. Reasons for non-adoption included technology-related (e.g. usability, functionality) and non-technology-related (e.g. competencies and context factors) issues, and facilitators for adoption were discussed in the FGs. Key aspects of application scenarios were enhanced technological support of direct nursing care tasks to reduce physical burden and mental stressors. Specifically, participants of the FGs expressed their wish for participative development and a general openness for nurses to be included in the development and testing of digital technologies.

Although efforts in development, research and theory-building have been increasing over recent years, DNT that go beyond more traditional or common applications within the ICT category (such as electronic nursing records or process planning) are rare. There are already technologies available for many of the expressed needs for which, however, adoption fails or does not happen. The reported barriers and facilitators indicate issues that should be taken into account when developing DNT for application in nursing practice. The study reveals a distinct need for information, counselling, facilitation and organizational development, and brings to light broad opportunities for the collaborative development of guided DNT implementation and evaluation processes. Future development and research activities should preferably be conducted by interdisciplinary research groups.